Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name (to be filled out by each adult in household) *FirstLastLayoutAddress *Postal Code *Telephone *Email *Would you like to receive notices from BRISC via email? *YesNoPreferred method of contact *EmailPhoneCanada PostEthnicity *StatusNon-StatusMetisOther (non-Indigenous)Indigenous Nation or TerritoryMembership TypeAdult Membership – $3.00Elder/Senior Membership – $2.00Honorary Membership – $0.00LayoutList children under 18AgeWould you be interested in Volunteering?YesNoIf yes, what skill or gift would you like to share?MEMBERSHIP RIGHTS AND ELIGIBILITY AS PER THE BYLAWS OF THE BRANTFORD REGION INDIGENOUS SUPPORT CENTREMembership is not valid until approved by the Board of Directors. Submit